Get Wellspan Occupational Health Employer Authorization Form 2019-2025

Filling out the WellSpan Occupational Health Employer Authorization Form online is a straightforward process that ensures your employee can receive necessary health services. This guide provides comprehensive steps to help you complete each section with confidence.

Follow the steps to accurately complete the form online.

1. Click ‘Get Form’ button to obtain the form and access it in the designated online editor.
2. Begin by filling in the employer's information, including the name and contact details of your organization.
3. Enter the employee's name and address accurately. If the employee is from a staffing agency, please mark 'Yes' and provide the name of the agency.
4. Designate an authorized individual by printing their name and providing their signature alongside their email address.
5. Input the employee's Social Security number and date of birth to validate their identity.
6. Select the reason for the visit by checking all applicable options, which may include work-related issues or types of physical examinations required.
7. For substance abuse testing, check the types required and provide any specific reasoning for this testing if applicable.
8. Complete any additional procedures and billing information as required, indicating if employees will be responsible for charges.
9. Use the comments section to provide any specific instructions or additional notes relevant to this authorization.
10. Review all inputs for accuracy before saving the form. After confirmation, you can choose to download, print, or share the completed form.

Complete your WellSpan Occupational Health Employer Authorization Form online today for efficient processing.